Getting started with licensure
Health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located. In response to the growing use of telehealth, many states are revisiting their licensure process to minimize barriers to access and ensure continuity of care, while also preserving state regulatory oversight.
State oversight of health care providers
The same standards for licensure apply to health care providers regardless of whether care is delivered in-person or virtually through telehealth services.
The licensure process is intended to protect the general public and to ensure patient safety, but due to time and costs it can be a barrier to providing care. To practice in a state, providers must meet many requirements, including documentation of educational qualifications, satisfactory performance on qualifying examinations, and participation in background checks. Health care providers are also expected to maintain and renew their license. In most cases, maintenance requires paying an annual fee, completing continuing education, and self-reporting any disciplinary actions or other matters of concern.
The National Conference of State Legislatures tracks scope of practice issues related to a range of health care practitioners.
Obtaining licenses to provide telehealth care in multiple states can be burdensome. Application requirements differ across states and each new license takes time to complete as well as has associated fees. The cost for a full license can vary by as much as $75.00 to $800.00, depending on the type of specialty area and state. As a result, many states are attempting to minimize the licensing barrier to provide care, while still prioritizing state oversight of patient safety.
States have broadened their cross-state licensure, including for telehealth services, oversight in several ways:
- Recognizing licenses in other states;
- Allowing for pre-existing provider-patient relationships to continue when the provider is in another state; and
- By only requiring telehealth registration, rather than a full license, to provide telehealth services.
A growing number of states are expanding pathways for out-of-state providers to practice telehealth in their states through telehealth registration. Out-of-state providers licensed in good standing in one state may provide telehealth services in another state after they complete that state’s telehealth registration requirements. Registered out-of-state providers do not have to obtain a state license to practice telehealth.
Under this telehealth registration pathway, there are certain state requirements and conditions. States have some variation in how they oversee telehealth registration. Typically, providers must meet these terms:
- Current, valid, and unrestricted license in another state;
- Not subject to any past disciplinary proceedings in any state where the provider holds a professional license;
- Must maintain and provide evidence of professional liability insurance;
- Must not open an office or offer in-person treatment in that state; and
- Must annually register and pay a fee with the appropriate state licensing board.
Multi-state licensure compacts streamline the licensing process across states through one application, while preserving state oversight of quality. Compacts allow specific health care providers, such as physicians, nurses, psychologists, audiologists and speech therapists, among others to practice in states where they are not licensed as long as they hold a license in good standing in their home state.
Providers are required to pay fees in order to participate in the compact, plus the cost of a license in any compact state where they wish to practice. For example, the Interstate Medical Licensure Compact (IMLC) explains the fee structures per participating state for physicians.
Federal government and interstate practice
Under the federal government, interstate practice of health care is permitted under certain laws and for particular patient population groups, including:
Uniform Emergency Volunteer Health Practitioners Act: For states that have enacted, this law applies during a declared state emergency. The law allows states to permit health professionals from other states to provide services without having to seek a license in the state where an emergency has been declared.
The Sports Medicine Licensure Clarity Act: This federal law protects sports medicine professionals licensed in their home state to provide services to an individual or team when those athletes are in a different state.
Health professionals employed by the U.S. Department of Veterans Affairs, the Indian Health Service, and the U.S. Department of Defense are able to provide services to the patient population in these three groups: Veterans, American Indians and Alaska Natives, and individuals working with the Department of Defense, respectively. State license, registration, or other state requirements do not interfere with the requirements of federal employment to provide health care, including telehealth, to these patient populations.
Licensing on Tribal Nations
Licensed health professionals employed by the Indian Health Service or a tribal health program are exempt from the licensing requirements of the state in which they are located to provide health services, as long as they are licensed in any state.
This exemption falls under the Indian Health Care Improvement Act (IHCIA) (PDF), which is the primary legal authority for the provision of health care to American Indians and Alaska Natives. The IHCIA was made permanent in 2010, as part of the Patient Protection and Affordable Care Act.
More information on providing telehealth is found in Best Practice Guide on Telehealth for American Indians and Alaska Native communities. The Centers for Medicare and Medicaid Services (CMS) has an interactive map on state tribal relations on health care.
State telehealth advisory committees
An increasing number of states have created a telehealth advisory committee to balance access and patient safety with state oversight of health care delivered through telehealth.
Telehealth advisory committees, also referred to as a taskforce or working group, generally monitor state data on telehealth encounters, out-of-state providers, and modalities of care provided, including audio-only. These committees are tasked with gathering data on telehealth practices nationwide to further inform their recommendations to the appropriate state regulatory board or legislature on optimal approaches to telehealth practice.
Curious about whether your state has a telehealth advisory committee? Want to find out more about their recommendations?
You can check telehealth legislation in your state, or contact the National Telehealth Policy Resource Center, to find out.